Making equitable choice a reality: towards safe, effective, and supported medical abortion outside the formal healthcare setting in the United States

Abigail Aiken, University of Texas at Austin

Project abstract

Women in the United States face an increasingly hostile climate towards abortion. Many now live in states where their ability to exercise their right to choose is in jeopardy. Focusing on Texas, my overarching goal is to inform strategies to increase access to safe medical abortion outside the formal healthcare setting (OFHS) via two routes: 1) self-sourced misoprostol with or without mifepristone; and 2) mifepristone and misoprostol via online initiatives. Supported by an intensive mentored career development and training experience, I will conduct a mixed-methods research project with four key aims. First, by assessing knowledge, accessibility, and acceptability of self-sourced medical abortion among a sample of women in Texas, I will identify barriers to access and unmet needs for information. Second, by examining the experiences of Texas women who have already attempted self-sourced medical abortion, I will gain essential information about women's needs for instruction and support. Third, I will conduct a comparative analysis with Ireland/Northern Ireland, where women face similar restrictions as Texas women, but where safe medical abortion with mifepristone/misoprostol is already available OFHS through online initiatives. Using high-quality data from Ireland/Northern Ireland, I will perform a rigorous assessment of the safety and effectiveness of medical abortion OFHS. Finally, by exploring Irish women's experiences with this pathway, I will draw lessons about aspects of care that are essential for a satisfactory experience. This project will lay the foundation for a career dedicated to helping women access safe and effective abortion and for future work in other US states.